Valerie Navarrette .. ,,
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WI I.
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EACH1 i C7,./ &,,,,,,,,_ Li-
/
, , DIVERSITY STATISTICS REPORTING .
Name: ..
Board I Committee: CO a)rn ; t-c-e- ,9-y■ -4-4--Q_ 40 r-r(S&I.o
Appointment Date: 3 ( 1 5
Pursuant to City of Miami Beach Ordinance 2009-3632, the-City is required to annually
prepare and present a repoit tb the 'City Commission identifying the City's diversity ..
statistics. This form allows board and committee applicants and members to voluntarily
self-identify their race, ethnicity, disabled status and gender. ...
Please check the appropriate box for each category:
.Gender: Male I Ii Female P-A
Race/Ethnic Categories
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What is your race? • ,•
. {D African-American/Black
1 Caucasian/White
1=1 Asian or Pacific Islander . .
- ,
, . .
[:3 Native-American/American Indian
• La Other— Print Race:
Do you consider yourself to be Spanish, Hispanic or Latino/a? Mark the "No"box if not .
Spanish, Hispanic, Latino/a. - •
• - .
No
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1 7
Yes -c •
i,
„.• 'L.:. , c ti, ,f ".. •
Do you consider yourself Physically Disabled?
• , - orN. .7. .
. izli Yes „'. . •
,..
' - I' s • - - • . . :,_..e ,.
111
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CAUsers\CENTFraN\AppData\Local\Microsoft\Windovvs\Temporary Internet Files\Content.Outlook\NP4J9CNX\BC minority
information form 05-20-13 FINAL.doc
Updated: Monday,January 26,2015 •
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